| Moderators and predictors of response to cognitive-behavioral therapy augmentation of pharmacotherapy in obsessive-compulsive disorder. | |
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MedLine Citation:
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PMID: 20416137 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cognitive-behavioral therapy (CBT) consisting of exposure and response prevention (EX/RP) is efficacious as a treatment for obsessive-compulsive disorder (OCD). However, about half of patients have a partial or poor response to EX/RP treatment. This study examined potential predictors and moderators of CBT augmentation of pharmacotherapy, to identify variables associated with a poorer response to OCD treatment. METHOD: Data were drawn from a large randomized controlled trial that compared the augmenting effects of EX/RP to stress management training (SMT; an active CBT control) among 108 participants receiving a therapeutic dose of a serotonin reuptake inhibitor (SRI). Stepwise regression was used to determine the model specification. RESULTS: Pretreatment OCD severity and gender were significant moderators of outcome: severity affected SMT (but not EX/RP) outcome; and gender affected EX/RP (but not SMT) outcome. Adjusting for treatment type and pretreatment severity, significant predictors included greater co-morbidity, number of past SRI trials, and lower quality of life (QoL). Significant moderators, including their main-effects, and predictors accounted for 37.2% of the total variance in outcome, comparable to the impact of treatment type alone (R2=30.5%). These findings were replicated in the subgroup analysis of EX/RP alone (R2=55.2%). CONCLUSIONS: This is the first randomized controlled study to examine moderators and predictors of CBT augmentation of SRI pharmacotherapy. Although effect sizes for individual predictors tended to be small, their combined effect was comparable to that of treatment. Thus, future research should examine whether monitoring for a combination of these risk factors and targeting them with multi-modular strategies can improve EX/RP outcome. |
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Authors:
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M J Maher; J D Huppert; H Chen; N Duan; E B Foa; M R Liebowitz; H B Simpson |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2010-04-26 |
Journal Detail:
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Title: Psychological medicine Volume: 40 ISSN: 1469-8978 ISO Abbreviation: Psychol Med Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-10-27 Completed Date: 2011-02-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1254142 Medline TA: Psychol Med Country: England |
Other Details:
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Languages: eng Pagination: 2013-23 Citation Subset: IM |
Affiliation:
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New York State Psychiatric Institute, New York, NY 10032, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Cognitive Therapy* Female Humans Male Middle Aged Obsessive-Compulsive Disorder / drug therapy* Prognosis Quality of Life Serotonin Uptake Inhibitors / therapeutic use* Severity of Illness Index Treatment Outcome Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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K23 MH01907/MH/NIMH NIH HHS; R01 MH45436/MH/NIMH NIH HHS; R01MH45404/MH/NIMH NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Serotonin Uptake Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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